Provider Demographics
NPI:1497044531
Name:OHIO VALLEY NEPHROLOGY ASSOCIATES PSC
Entity Type:Organization
Organization Name:OHIO VALLEY NEPHROLOGY ASSOCIATES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SEATON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-689-1919
Mailing Address - Street 1:1930 E PARRISH AVE
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1443
Mailing Address - Country:US
Mailing Address - Phone:270-689-1919
Mailing Address - Fax:270-689-1990
Practice Address - Street 1:1602 MAIN ST
Practice Address - Street 2:
Practice Address - City:TELL CITY
Practice Address - State:IN
Practice Address - Zip Code:47586-1310
Practice Address - Country:US
Practice Address - Phone:812-719-4237
Practice Address - Fax:812-547-1150
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OHIO VALLEY NEPROLOGY ASSOCIATES PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200341690AMedicaid